Making Sense of Tinnitus Treatment Options

 

Finding the Right Tinnitus Management Tools
Because, in many ways, tinnitus education is primary.

Okay. And so, we'll be talking more about that.

But, uh, so finding the right treatment or finding the right management tools can be really tricky these days. You know, people who mean well, maybe some people that don't mean so well, are coming up with all this stuff, and the internet gets packed with it.

And it's very hard for somebody who just wakes up one morning and, boom, they are struggling with tinnitus to find what really works.

And so, I'm going to set—instead of, at this time, going into specific things that work—I'm going to share with you the qualities of a good tinnitus management program, so that whenever something comes up, you know, the listeners can make educated decisions as to what would work, what wouldn't work for them.

So, again, you know, I have to go back to the tinnitus education piece for a moment to really start us out by saying tinnitus is a benign body sensation that the brain thinks is important to pay attention to when, in fact, it can very safely push it into the background.

So, it's important to set us up with that main definition that's unchangeable.

And so, we have to understand how the brain behaves when it makes an error and thinks something is connected to fear, or should be connected to fear, and how we help the brain to disengage from fear so that, again, the lens can open up and we can move on to more important things than tinnitus.

Um, I can also sound very easy-breezy about tinnitus because it's very hard for me to get excited about a benign body sensation. But it is not lost on me that tinnitus is devastating for millions and millions of people, both in this country and across the world.

So, I'm going to really share with you three qualities to look for in any tinnitus treatment.

And so, whether, you know, whatever you find out there, it should fall into one, two, and hopefully all three areas.

The Three Qualities of Good Tinnitus Treatment
Number one, reducing anxiety around tinnitus.

Okay? We spoke in our last segment about how tinnitus—I use my hands a lot—but tinnitus right here is, in and of itself, benign.

But there's a fire below it.

And the fire below it is a picture of anxiety, stress, anxiety, vigilance.

And so, once you know, a good treatment moves tinnitus off to the side because it is benign and shouldn't be very interesting to the brain.

But what we're left with is the fire below it.

So, this fire below it has to be addressed.

And what we find is, you know, tinnitus was never really the issue.

And what we find is when we manage the anxiety, the entire world is a different place for people with bothersome tinnitus, or now non-bothersome tinnitus.

But, um, so again, reduction of anxiety, calming the nervous system.

Number two, making sure you're an expert in tinnitus.

Okay?

Human brains function better when they understand.

And so, it doesn't matter if there's some crazy mountain to climb or some chaos going on. But when we start to understand what's ahead, we can take a deep breath and start plotting our path forward.

Okay?

Tinnitus, in many ways, is kind of a stuck disorder.

You know, people get stuck in that tinnitus loop, and, you know, it's largely based in fear, frustration, all those things that can keep us tight and stuck around it.

And so, through education, we can kind of soften, loosen, open our hands to it and hold it in a different way and start planning the next step forward.

I call it, instead of reacting to tinnitus, responding to tinnitus.

Right?

So, any treatment that you would find has a very, very clear and accurate—I have to be accurate with that word—accurate education component to it.

Okay?

And then number three, again, we're working with the nervous system.

And we'll talk about that a little bit more, but the nervous system, you know, finding ways to bring down the fire, finding ways to reduce stress consistently—not just, you know, in the moment to moment, but a consistent reduction of stress helps us to live with more choice and freedom in our lives.

So, any treatment that we do, again, will involve reduction of anxiety, clear education, which can also be hard to get, you know, in our day and time.

You know, education or accuracy or facts can be kind of manipulated.

But anyway, education is key, and then this autonomic nervous system reduction on a consistent level.

So, it's finding consistent stress-reduction tools that will then make it such that the lens doesn't need to get locked and loaded around tinnitus anymore, and it can open itself up.

Now, tinnitus might still be there, but it's within the context of everything else going on.

And because it is a benign body sensation, the brain's going to get bored with it.

And the brain's going to do with tinnitus what it does with every other benign body sensation, every other boring body sensation.

What does it do?

Ah, it does us a favor and it pushes us out of awareness.

So, again, I think it's really important for us to set up today's talk by understanding the components that will—that anybody, 100%, can shift tinnitus from bothersome to non-bothersome.

Why Anxiety and Stress Are Different
Sher: Absolutely. That's a great framework, and I personally love frameworks because it helps you take any type of possible treatment that you might encounter and take it through these different steps.

And so, understand, even if there's something new that comes out, you know, two years from now, you can apply that same framework to it.

So, I think that's very helpful.

But for some people, you talk about lowering the anxiety and then also lowering stress, and that might sound like the same thing.

Can you talk a little bit more about why those are not the same thing and those are two separate aspects of it?

Dr. Gans: Well, the anxiety part is—many of the people I've sat now for thousands and thousands of hours with people with bothersome tinnitus.

So, again, I'm not making any assumptions about the non-bothersome group because they don't come in to see me.

But I have learned so much about the bothersome group of tinnitus that, you know, I have to share with you what I know.

You know, this is what I've seen day in, day out for several years.

And what I have found 100% of the time is that everybody that has bothersome tinnitus is struggling with some form of anxiety.

Now, it can be diagnosable anxiety. It can be also just kind of a hypervigilance.

And that hypervigilance can be caused by environmental things.

I mean, you know, the world is at war in many ways, so there are people around the world that are, you know, the volume of their vigilance has been turned up immeasurably.

So, you know, we can be—you know, traumas can happen that kind of dials up our vigilance.

So, you know, these are—you know, the anxiety part is something that's very conducive to talk therapy, and in severe cases—or not severe cases, but in cases where a person's particularly stuck in anxiety, you know, I say everything from education to medication.

You know, I see things—everything seems to be in a spectrum.

But education is number one.

Okay?

So, if there are choices for how you treat anxiety, or tinnitus for that matter, I see it as a one to 100—or I'm sure there's thousands more things you can do, but I'm just, for clarity, saying one to 100.

One is education.

Okay?

With education, you know, you're opening yourself up to many, many other treatments.

But without accurate education, the brain doesn't function as well. It plays out of tune.

You know, it's, uh—

So, this anxiety, what I'm seeing in the patients is they come into my office.

Actually, you might see up here a violin on the wall.

So, um, let me explain a little bit how I see my patients when they come into me.

For those who know about violins, there's this beautiful violin called a Stradivarius.

And this is the most precious, or one of the most precious, violins out there.

And so, when a person is sitting in front of me with bothersome tinnitus, I feel like I'm sitting with this beautiful, beautiful violin.

And everybody knows that violins have four pegs on them and these strings.

Now, it's as if I'm sitting with a violin that has all their pegs super, super tight—

Sher: And they're coming in and they're playing their violin and it is sounding sharp and it is not making music. And even Joshua Bell couldn't make good music out of a violin that is not in tune and is playing sharp.

Dr. Gans: And I mention sharp because when I think of something being tight, I think of anxiety.

Now, if the strings are too loose, you could think of it kind of as depression, which, you know, can sometimes be bedfellows.

But, um, initially, when I'm seeing patients, they're—it's as if I'm, you know, I'm helping them not to throw out the instrument because it's beautiful.

It's a beautiful instrument.

Nobody would throw out an instrument that was out of tune.

What would we do?

We would simply loosen the strings a little.

So, that's the anxiety part.

And one to 100 can be anything, or starting with education, but in some cases it means medication.

And there are wonderful medications that help people with anxiety.

So, stress, I see that—I mean, I guess there is certainly some crossover—but autonomic nervous system regulation, our ability to consistently create an environment where we have some choice and freedom, where we have some space to respond to life, and certainly in this case, respond to tinnitus in new ways instead of those old reactions that obviously weren't serving them.

But with education, responding to tinnitus in a new way.

And so, sometimes people are—you could blame this on genetics.

Sometimes people are just born with higher levels of anxiety.

The amygdala, which is in the fear center, is just more alert, more on guard.

And so, for some of those people, it's hard for them to take in education.

If you are playing with your strings super tight—I mean, they're about to snap—you can't even take in the good. You can't even take in the education.

And so, for those people, sometimes they reach out to medication to support them so that they can then take advantage of the three things that are going to get them to the goal line of shifting tinnitus from bothersome to non-bothersome.

Sher: Okay. No, that's definitely helpful. Thank you.

Mindfulness-Based Tinnitus Stress Reduction
Sher: All right. So, let's dive into some treatments, and let's start with maybe some psychological and behavioral treatments.

I know we talked about meditation last time. I know that's something that's worked for me personally with my tinnitus, but maybe we can go deeper on just mindfulness-based tinnitus stress reduction.

You know, what is that, and how is it different from just relaxing?

Dr. Gans: Yes. Well, I'm glad you bring that up because this is obviously something that is very dear to me.

I've seen it, you know, help countless number of people.

So, I—you know, I guess in many ways I was one of the pioneers bringing mindfulness meditation to the field of tinnitus.

And it's not to say that I think it's the only way, but let me explain to you why I think it should be part of everybody's life.

Now, we spoke before about tuning the instrument.

Now, what does meditation do to the brain?

And, you know, meditation—you could actually, you know, that's such a big word these days and it means so much to so many people.

You could also call it awareness building.

Okay?

Because from a place of awareness, we can start to see what's not serving us, and we can start to remove what's not serving us and replace it with more of a response.

So, what I love about mindfulness is that it wasn't designed to fix anything. It wasn't designed for anything in particular, anything specific.

It's not designed to do anything for us.

But one thing that it does very, very well is it tunes the orchestra of the brain.

And so, you know, I actually have a daughter who was curious about the brain.

So, I went to the internet and I got a picture of the brain up on the screen, and I looked at it and it was color-coded, like the occipital lobe was pink and the auditory cortex was brown and the, you know, all the different—you know, the prefrontal cortex was purple.

So, all these different sections of the brain, and I was like, gosh, that looks like a symphony.

Because when you think about a symphony, you think of the different sections. Each one, in and of itself, is beautiful, but it doesn't really create the symphony until they're all playing in concert.

And so, the way that I—and originally my thinking about bringing mindfulness to the field of tinnitus was because we have to find a way—there's nothing broken with tinnitus.

It's the brain misunderstanding a benign body sensation and bringing it to the top of the triage, you know, into the number-one slot.

And when it's connected with fear, it keeps the attention on it.

So, what mindfulness brings to the field of tinnitus is that it brings an awareness building.

And, for example, if you're conducting an orchestra and the concertmaster gets up, they stop, they pay attention, and they listen very carefully to each instrument so that all the violins and all the trumpets and all of the bassoons and all the flutes, they're all playing in the key of, let's say, A.

They're all in tune.

And then, you know, beautiful music can come from there.

So, what I love about bringing mindfulness-based approaches to tinnitus is that it's really—it's, again, it's not designed to fix anything, but it really—this course that I developed really follows the three rules.

Number one, reduction of anxiety, as we have seen in the research and, you know, for decades now, about how mindfulness approaches help with things like anxiety, depression, sleep difficulty.

I mean, this is incontrovertible.

This is, um, you know, the science is out, and we know that these approaches help people with these difficult, you know, with the imbalance, you could say, in the mind.

So, this course that I've developed helps reduce anxiety around tinnitus.

Every lesson, every exercise is all based on accurate education about tinnitus.

So, that part is snuck in.

And then it starts you off on a mindfulness meditation practice.

And that's where—it's almost like if you go to the gym and you lift a barbell enough times, you're going to build muscle.

Well, what this mindfulness practice is really designed to do is strengthen our awareness muscle.

You could think of it like that.

Because, you know, if our mind is just off and whatever, we don't even know what we're reacting to, we're just going on being.

But with a mindfulness practice, we're tuning the orchestra of the mind so that we can be aware and notice when the mind is going into old tinnitus reactions.

We can spot it, note it, let it go, and come right back to the moment.

So, we can start creating some space and freedom so we can replace those with responses.

Developing the MBTSR Program
So, you know, in description—so, when I was at UCSF several years ago, I became very interested in all—I was at the cochlear implant center, and so many of our patients are obviously coming in with severe to profound hearing loss.

And it was my job to do evaluations with everyone, and a lot of people were mentioning tinnitus.

And nobody, nobody really would touch it.

You know, the doctors are kind of like, “Okay, well, let's focus on—let's focus on your hearing loss. We'll deal with tinnitus later,” or just not deal with it at all.

And so, me being who I am, I got very curious about it.

And so, that's when I started a research project and took the work of John Kabat-Zinn, who developed Mindfulness-Based Stress Reduction, an eight-week program that, you know, has shown in the research is being incredibly effective at helping people, again, tune their orchestra.

So, I took his program and I said, “I wonder if this would help people with bothersome tinnitus.”

So, I flipped that into a research study and called it Mindfulness-Based Tinnitus Stress Reduction.

Now, the results we got were phenomenal, and I flipped it into an online course found at MindfulTinnitusRelief.com.

And now this course is being used all over the world.

It's translated into multiple languages, three languages right now, and people are using it all over the world and finding the relief that they're needing through reduction of anxiety, amazing education—or accurate education—as to what tinnitus is, which is hard to get, and then starting them off on a mindfulness meditation practice that, by the way, helps them far beyond tinnitus.

Sher: Of course. Yeah.

Dr. Gans: So, it's kind of a sneaky way to, you know, to improve, you know, improve everything.

And so, it has legs.

You know, it's not just about today. It's about the future.

And so, this course, again, has been very, very helpful to so many.

A Rule of Thumb for Tinnitus Management
Now, let me give a rule of thumb also for any treatment that we find.

Stress increases tinnitus bother, likely increases tinnitus bother, and relaxation decreases tinnitus bother.

So, really, any treatment or any management program or tool that you use, listen to that fact: if whatever is being done is stressing you out, it's probably not going to help you with bothersome tinnitus.

Anything that relaxes you, again, is going to create that openness so that your brain can take this benign body sensation, make it boring, and push it into the background.

So, through this course, there's also a cognitive behavioral therapy component to it.

So, that's also been shown in the research to be very, very effective, and I use it in my clinical work, of course.

And there is, of course, a cognitive behavioral aspect to the MindfulTinnitusRelief.com course because, if you think about it, we're using cognition to change our behavior.

That's what we're wanting. It's behavior change here.

And so, yes, you could argue that the educational piece is kind of debunking erroneous thoughts and replacing them with accurate thoughts.

So, there's a lot of mixing and matching of different techniques here.

So, we don't want to put any one in a particular silo.

And, you know, I'm a big fan of throwing in the kitchen sink, but, you know, programs like this do.

Now, I do have to say that there is not a program out there, there is not a management tool out there, that is going to be effective if the person does not have accurate education.

Because without accurate education, the person runs the risk of connecting tinnitus to fear.

And when we fear something, we, again, get very focused on it.

And so, our goal ultimately is to make tinnitus boring.

So, no matter what treatments people choose, the accurate education piece is critical.

Now, that can certainly be found in the MindfulTinnitusRelief.com course.

Now, if you go to a CBT therapist, which is also a wonderful way to work with anxiety, there has to be an accurate tinnitus education component to it.

And many, you know, many, many do, hopefully all do.

So, and then, you know, there's a lot of other stuff that's being out there on the internet, and people have to be careful what they're literally buying into.

I personally don't think people should spend money on tinnitus. I just don't.

You know, because—but I think they, you know, if there's, you know, if there's something that helps with anxiety and that can sometimes cost money, I'm a big fan of it.

But the tinnitus part can be very, very tricky.

There's a lot of people out there, and they're not, you know, they're not trying to do harm, but, you know, we'll use different tactics and techniques to get people to buy something, and that can lead to a lot of frustration and hopelessness.

And a failed management tool is, you know, is very frightening to the person.

So, you know, there are some things to look out for.

Again, kind of goes back to those three things:

Accurate education, reduction of anxiety, and stress reduction.

Sound-Based Therapy
Sher: Right. So, let's move away from some of the more psychological things.

There's also, I guess, sound-based therapy that can be very popular, right? Sort of blocking the noise with white noise, or hearing aids can do that.

What are your thoughts on some of these sound-based treatments, and is there evidence behind their effectiveness?

Dr. Gans: Yes. And, you know, logically it kind of makes sense in a way to use a sound therapy, but the problem with that is that there's too much focus on sound.

Sound is not the problem of the person with—I mean, it feels like it's the presenting problem, but it isn't the actual—it isn't the underlying problem.

And really, whenever we're working with any kind of ailment or what have you, we want to look for the underlying problem.

And so, yes, now going back to what I said, anything that stresses you out makes tinnitus likely more bothersome.

Anything that relaxes you makes tinnitus less bothersome.

And sound—ears love to hear.

Ears want to hear so badly that, in the absence of sound, the brain creates sound.

So, I say to all of the people I work with, well, fill your environment with sound.

Your ears want to hear.

Or give them something to hear, at least temporarily.

Don't be in a quiet room.

Fill your room with background noise that is stress-relieving for you.

Now, different people are attracted to different kinds of sounds.

Some people can sleep to crickets.

Some people like to sleep to white noise.

Some people like to sleep to purple noise.

Some people like to, you know, the rushing river or fire or music.

So, you know, we want to use sound to help the brain reduce stress.

We want to help the brain to relax.

But we don't want to get ourselves into a situation where we are measuring, checking—you know, there's the problem that we have—

Bless you.

[laughter]

The problem that we have with sound therapies is we end up focusing so much on the sound.

You know, pitch matching and making sure that the sound is just the right volume—that goes not too far, but not too little.

And what ends up happening is the person, instead of just taking in sound, all of a sudden is making tinnitus more interesting to the brain because it's making all those minute and sometimes massive comparisons.

And, you know, even clinicians can get a little bit too into the weeds.

We all want to, you know—there's, I guess, what I have found most successful with people is making tinnitus boring to the brain.

And anytime we measure, anytime we check, anytime we connect anything to tinnitus, it runs the risk of making the brain interested in tinnitus.

And that's the opposite of what we want to do.

So, yes, sound therapy—I mean, call it sound therapy or just call it sound.

I think sound is a wonderful thing.

It's—ears love to hear.

So, let our ears hear.

Hearing Aids
Now, this actually brings us to the second part of your question.

It was about hearing aids.

Now, a lot of people will ask—this is one of the first questions that I hear, you know, when I'm giving some talks—is, you know, do hearing aids make tinnitus go away, or do they do they—what have you?

And so, again, that follows the rule that ears love to hear.

Now, if you have a significant hearing loss, and many of us do, I say find yourself the best audiologist in town.

And there are so many of them.

And go get yourself one of these amazing hearing aids that, you know, blows my mind what they come out with.

It's pretty spectacular.

So, if you have hearing loss, yes, go get a hearing aid.

But what happens for all of those people who come to have bothersome tinnitus, but they have either mild or not even measurable hearing loss?

Now, they all have hearing loss, but sometimes it's well beyond the 8,000 hertz that we stop testing people at.

So, you know, there are a lot of people out there with bothersome tinnitus who are not candidates for a hearing aid.

And what happens when you put a hearing aid on somebody who's not a candidate for a hearing aid is they do this.

They rip them out.

It would be kind of similar to, like, if I put glasses on somebody that didn't have—that didn't need a prescription.

I'm putting a big prescription on them.

You know, they're not going to be able to see. They're going to rip those glasses off.

So, while some people feel that when the hearing aid is picking up more sound, it's giving more noise or more sound to the ears to chew on, tinnitus feels less bothersome because it's also less stressful when we are able to hear better.

So, there's multiple things going on.

But for somebody who needs a hearing aid, putting on a hearing aid is likely going to reduce stress in their mind because they don't have to work so hard to hear and will likely make tinnitus feel less bothersome.

The brain will maybe focus on it less.

Now, that leaves, again, a certain percentage of people with bothersome tinnitus out in the lurch because, you know, putting on a hearing aid is more pain than it's worth.

So, that wouldn't be a case when a hearing aid would be indicated.

But it's still okay.

First of all, congratulations. You've got awesome hearing.

So, you could look at that as kind of a compliment.

But there's multiple other things people can do to help them reduce the stress that keeps the mind locked and loaded on tinnitus.

Hearing Aids and Brain Adaptation
Sher: Right. And I think another thing important to add about hearing aids is that they aren't going to be sort of these miracle, you know, glasses-type things where you put them on and all of a sudden you're hearing, you know, perfectly or normally or whatever kind of word that you want to use.

It's something that the brain has to get used to.

It may have been a very long time that people haven't been hearing certain frequencies or certain sounds.

And so, there's going to be this adjustment process.

So, you know, I would hope that people would put them on and, if it didn't work perfectly, not say, “Well, these aren't for me.”

No, no, no. They may be for you.

It's just that this is part of the process of a hearing aid, right?

It's that it's going to take that time to adjust and have your brain learn that new way to hear.

It's sort of like having—it all comes down to the brain, right?

And how the brain takes this new information and can learn how to process it to be most effective for the individual.

Dr. Gans: And I'm a big fan of hearing aids.

I mean, this is not to say that no, don't use hearing aids.

I say use them wisely and, you know, use them accurately.

Now, there is another feature to pretty much, I think, all hearing aids these days.

They have sound generators as part of—yeah, as part of the hearing aid.

So, that can be very useful because, you know, here I am saying just fill your environment with sound.

Well, what happens if somebody else is in the room or you're in a work situation or whatever, and having sound in the room wouldn't work for other people?

So, having these ear-level sound generators can be very helpful.

Now, again, you know, I kind of laugh a little bit, but remember, stress reduction is a critical part of relaxing the brain so the brain can then become bored with tinnitus and let it go.

Well, hearing aids are expensive in this country.

You know, I can't speak to other countries because they have different kinds of medical programs and what have you.

But here in the United States, you know, hearing aids can be upwards of $7,000, are very, very expensive.

And so, spending a lot of money on tinnitus can be stressful.

And so, in the service of trying to relax the person, you know, there are other ways of getting sound in that don't involve using behind-the-ear sound generators.

I mean, again, you could fill the room.

You could put on headphones.

I mean, there's other ways of bringing sound to your mind that doesn't bother other people.

They have sound pillows where, you know, at nighttime, you could be piping in sound through the pillow so that the person sleeping next to you isn't bothered by it.

So, you've got to be creative with sound.

And it shouldn't cost money.

It shouldn't cost a lot of money.

Anybody that has a smartphone has access to all kinds of sound.

So, you know, I encourage people to use sound to the point where it relaxes the brain.

Herbal and Pharmaceutical Treatments
Sher: So, let's turn now to sort of herbal or pharmaceutical treatments.

I feel like there's a lot of excitement that I see on the internet about this, but it always gets my sort of, you know, spidey sense going.

I feel like there's a lot of nefarious claims that are made.

Are any of these types of treatments on the horizon that give you hope, or is this just all a bunch of bunk at this point?

Dr. Gans: Well, you know, it's only bunk to somebody who doesn't necessarily work for it, because this goes back again to what I had said before.

Anything that stresses you out will make tinnitus more bothersome.

Anything that relaxes you will make tinnitus less bothersome.

So, if you are that person who takes an herbal supplement and it relaxes your system, you could argue that, you know, chances are you'll be less bothered by tinnitus.

And so, now, you know, the FDA is not in charge of our herbal supplements.

So, you know, we have to be very careful about claims that they make and the rigor of their claims.

And we don't want to do anything that's not healthy.

But, you know, again, this is the rule of thumb.

If taking a supplement relaxes you, yeah, it'll help you, probably, with bothersome tinnitus because a lot of us have imbalances.

You know, if, um—you know, let me use coffee, believe it or not.

Coffee and salt as a good example, and it definitely proves this point here.

So, there are—there's lots of claims out there. I see it online all the time.

“Oh, well, if you have tinnitus, stop drinking caffeine,” or “If you have tinnitus, reduce salt in your diet.”

Well, here's how this works.

Caffeine doesn't cause tinnitus.

We know what causes tinnitus.

You know, the brain is searching for a sound that is no longer able to hear.

Sher: And here—how apropos. You're drinking your cup of coffee.

Dr. Gans: I love it.

Sher: Well, apropos in that, um, for example, if you told me that I couldn't have a cup of coffee tomorrow morning, I would be exactly—

Dr. Gans: See, you and I are in the same boat.

Sher: I would be stressed to no end for the rest of the day, and chances are my tinnitus would bother me more.

Dr. Gans: Now, there are people—and obviously we're not in our company right now—where the idea of drinking a cup of coffee would make them stressed out because not because of caffeine necessarily affecting tinnitus, but caffeine affecting the metabolism of the system.

And, you know, for some people, it makes them jittery.

Other people, it doesn't make them jittery.

It doesn't make me jittery. It makes me happy.

So, you take my cup of coffee away, nobody wants to be around me.

But, so, this is the rule of thumb: How does it make you feel?

So, for people who become very jittery when they drink coffee, chances are their tinnitus is going to bother them more.

So, yeah, they probably should cut out coffee.

Now, for, you know, somebody who loves their cup of coffee in the morning, you know, to cut that out would make them so miserable that their tinnitus would bother them more.

So, it's the same thing with salt.

If we have too much salt in our diet, it can affect a body in a different way than no salt.

And so, you have to ask yourself, where do I fall on that continuum?

There are some people where a non-salt diet—you know, life isn't worth living unless we have some flavor in our food.

So, they would do very, very poorly with their tinnitus if they took out salt from their diet because their pleasure—their pleasure from food would be gone.

But then there are people who have too high of a salt diet, and that stresses their system out in such a way that they would become tighter around everything, not just tinnitus, but just about everything.

So, I hope you hear the, you know, when we're looking for what will help us, the question is: How does this affect my system?

And also, it's not always nefarious with these herbal supplements that come out, because if somebody tries it and it works for them, they think it's going to work for everyone.

But again, it depends on the person.

So, you know, if you think it's safe to try a particular herbal supplement, maybe it will relax your body enough so that tinnitus can feel less bothersome.

But this—this is not—it really depends on the individual.

Bringing It Back to the Trifecta
Sher: Yeah. I mean, I think that's all of this is what you're saying, is that it really comes down to the individual, which is so true, but also so frustrating in a way, right?

Because it's like what works for my friend might not work for me.

But I can take those same concepts and that same framework and figure out how I can make that work for myself or find the thing that helps me to lower that anxiety, etc.

Dr. Gans: Well, let me narrow that down a bit, if I could, because you're right.

You know, every single person that I've seen over the years—thousands and thousands of hours of time with people with bothersome tinnitus—everybody is unique.

And that's probably why I love my job, because it's fresh and new every day.

However, every single person that falls into the bothersome category—I mean, go back to the last part one of our talk to understand really the difference between the bothersome and non-bothersome group.

But everybody that I see has three things in common.

And so, if we understand that, that there are certain things about every single person in the bothersome group of tinnitus, then we can narrow down treatments.

They have—you know, everybody in this bothersome group has some form of hearing loss, measurable or not, because you have to lose something in order to fill it in.

Number two, everybody in the bothersome group has some form of stress, autonomic nervous system arousal.

So, this has to be worked on.

Whatever treatment it is has to, again, bring it down, whether it's cutting out coffee or keeping drinking your coffee.

And then number three, every single person in this group has an amazing personality that we spoke about in our first talk, where they're very vigilant.

They're very alert, aware, and if they spot a problem, they like to latch on to it and they have trouble letting it go until they figure it out.

Sher: Mhm.

Dr. Gans: And this really speaks to the fire that's below tinnitus, that kind of vigilance, that anxiety that is common throughout.

So, I encourage everybody with bothersome tinnitus to look first to manage autonomic nervous system arousal, reduction of stress and reduction of anxiety.

That plus good education and tinnitus is the—that's the trifecta that's going to get everybody to the goal line.

Sher: I love that. I think that's sort of a good point to end on.

So, thank you so much for being here again on the podcast.

And for listeners who want to follow your work or dive deeper into some of this, where should they go to find you?

Dr. Gans: Well, as we've mentioned before, there is MindfulTinnitusRelief.com.

And I encourage both clinicians and also, you know, people all over the world to sign on.

I have even a blog section there of just free articles that I've written on different topics.

Anytime somebody asks me a question about tinnitus, I try to just sit down and write a quick article about it.

So, you can find some answers there.

You can certainly sign up for the course there.

And there's also my email is on that so that you can get in contact with me if you have any questions.

Sher: Awesome. Well, thanks so much, Jennifer. Great to see you.

Dr. Gans: Well, great to see you, Sher. Thank you so much.

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